MEDICARE: DR. JENNIFER MILLS PRICE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1064	WV
2	103TC0700X	Clinical Psychologist	1064	WV
3	103TF0200X	Forensic Psychologist	1064	WV

General Provider Information

NPI Number	:	1225339153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MILLS PRICE PSY.D.

Provider Business Mailing Address
First Line	:	1335 VIRGINIA ST E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-3011
Country	:	US
Telephone Number	:	800-983-2875
Fax Number	:	800-983-2875

Provider Business Practice Location Address
First Line	:	1335 VIRGINIA ST E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-3011
Country	:	US
Telephone Number	:	800-983-2875
Fax Number	:	800-983-2875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	01/09/2015

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